The tree of life.  I decided it was an appropriate choice for a henna tattoo on my exposed right calf while the left calf was encased in a black compression sock.  I limped around the Minnesota State Fair a week after I was diagnosed with a blood clot–a DVT (deep vein thrombosis) with suspected PE (pulmonary embolism)—and decided to take a load off my feet at the henna tattoo parlor.  One never knows what may be lurking inside the human body.

March is Blood Clot Awareness Month

The Center for Disease Control (CDC) has posted these statistics and sobering facts, reminding us that blood clots can affect anyone:

• The precise number of people affected by DVT/PE is unknown, but estimates range from 300,000 to 600,000 (1 to 2 per 1,000, and in those over 80 years of age, as high as 1 in 100) each year in the United States.
• Estimates suggest that 60,000-100,000 Americans die of DVT/PE (also called venous thromboembolism). Among people who have had a DVT, one-half will have long-term complications (post-thrombotic syndrome) such as swelling, pain, discoloration, and scaling in the affected limb.
  • 10 to 30% of people will die within one month of diagnosis.
  • Sudden death is the first symptom in about one-quarter (25%) of people who have a PE.
• One-third (about 33%) of people with DVT/PE will have a recurrence within 10 years.
• Approximately 5 to 8% of the U.S. population has one of several genetic risk factors, also known as inherited thrombophilias in which a genetic defect can be identified that increases the risk for thrombosis.

My Blood Clot Story

I am not sure I will ever look at flu symptoms the same. In late August, I had what I thought was a bad flu bug that came on suddenly. When I got out of bed that morning, I felt fine, but after I went downstairs to the kitchen to make my coffee, I felt like I was suddenly hit by a truck, with lightheadedness or a wave of nausea. I made a beeline for the couch and curled up, thinking perhaps it was food poisoning or sudden-onset flu. Contemporaneous with this–and one of the red flags of the symptom complex–was the fact that my calf was horribly painful and swollen.

To be honest I cannot recall if I had calf pain upon waking,  or if became apparent as the day went on, but certainly by afternoon I was obviously limping.  Companions to the painful calf were an overwhelming sense of fatigue and periodic episodes of sweating (that I chalked up to a fever—but never took my temperature) … and then I passed out in the bathroom. With no other health issues, though, I waved off my sons’ concerns.  “Mom, don’t you think you should go to the doctor!?”  I assured them that I would go to the doctor the next day if I continued to feel this awful, but was sure it was just a bad flu bug and I needed to lay down and rest.  My son claims I passed out while on the couch, and I told my son I just needed to sleep.  Sure enough, by the end of the day, I felt like I was recovering from a nasty illness—weak and tired, but appetite slowly returning.  I managed to get down a bowl of soup without it coming up again, and I was certain I was on the mend.

The next morning, I still felt tired (that post-flu weak feeling), but my calf was the real problem—it was warm, swollen and painful.  It had been difficult to sleep due to the discomfort.  I chalked it up to the joys of aging (cripes, I can’t even remember how I pulled a muscle anymore?! — I figured I had pulled my calf muscle while running with the dog and it was a delayed reaction).  So, I went to work and went to my son’s cross-country race for a couple of hours, hobbling around the course while my friends joked about not standing too close, due to my “illness” the day before.

I woke the third morning, a Saturday, with no improvement in my calf symptoms. This was a concern to me … our annual Minnesota State Fair trip was less than a week away.  How could I possibly cover all the usual food-on-a-stick territory if I couldn’t even walk without a pronounced limp?!  It was not weight-bearing as much as flexing the foot which caused the worst pain—and it was keeping me up at night.  Continuing to play WebMD, I self-diagnosed an alternative to a muscle strain: I must have a myositis that settled into my calf from my flu-type illness (yes, I am certain that I am every doctor’s worst nightmare).

Motivated by the desire to move more freely at the State Fair, I drove myself to Urgent Care as soon as they opened Saturday morning, and told my husband there was no reason for him to delay heading to the cabin.  I was sure it was nothing to worry about.  The doctor ordered an ultrasound of my leg, and much to both of our surprise, the ultrasound results revealed that I had a blood clot in my calf.  Given my presentation and history, he would have guessed it was a muscular sprain/strain, due to the lack of typical blood clot risk factors: I am healthy, in my 40’s, no chronic medical conditions, and very active. After consulting with the internist on call, I was started on the blood thinner Coumadin, and I showed the nurse I could give myself the Lovenox (Heparin) injections in my stomach without freaking out before I returned home.  Because my vitals were stable, I was allowed to start the blood thinning therapy on an outpatient basis.

The internist I saw a few days later believed my “flu” symptoms were likely signs of a pulmonary embolism (PE). I probably threw a blood clot from my leg when I got up that morning.  I had recalled “pulling a muscle” in my calf about six months earlier, and again could not remember any specific incident, but assumed it occurred from twisting and turning on the ice while running or walking the dog.  I did not have accompanying “flu” symptoms at that time, and after a couple of weeks, the calf symptoms appeared to resolve.  The doctor indicated that the earlier calf pain was likely a blood clot or the same clot that had recurred.

Because of my minimal risk factors, the doctor labeled my clot as an “idiopathic” DVT. The only potential risk factor I presented with was a longstanding prescription of low-dose birth control pills, which my OB/GYN had kept me on (due to my lack of risk factors!) to help manage perimenopausal symptoms through menopause.  After a few weeks of the Heparin/Lovenox until the blood thinners reached therapeutic levels, I remained on Coumadin for six months.   At my 6-month check-up, with no signs of new clots or further PE symptoms, I went off the Coumadin, and will remain hypervigilant to signs of recurrent clotting, and will consider any hormone-based therapy incompatible with my medical profile now.  Wearing a medical compression sock on the affected calf for at least a year is recommended.

I recognize that I am incredibly fortunate that the bullet whizzed by overhead as I ducked, oblivious to the danger. I passed out at least twice; in hindsight, I am grateful that was not the end of my story.

I encourage you to share this message and spread the word during the month of March, DVT or Blood Clot Awareness Month, by sharing the signs and symptoms, links or stories found through them, or by reblogging this post.  Someone’s life may depend on it. 

 SIGNS AND SYMPTOMS (Courtesy of the Mayo Clinic):

DVT Symptoms:

• Swelling in the affected leg, including swelling in your ankle and foot.
• Pain in your leg; this can include pain in your ankle and foot. The pain often starts in your calf and can feel like cramping or a charley horse.
• Warmth over the affected area.
• Changes in your skin color, such as turning pale, red or blue.

Pulmonary Embolism (PE) Symptoms:

• Unexplained sudden onset of shortness of breath
• Chest pain or discomfort that worsens when you take a deep breath or when you cough
• Feeling lightheaded or dizzy, or fainting
• Rapid pulse
• Sweating
• Coughing up blood
• A sense of anxiety or nervousness

Mayo Clinic’s guidance is to consult with your doctor if you have signs of a DVT, and to seek medical attention immediately if you have symptoms of a PE.

Additional general web resources on signs and symptoms of PE and DVT, treatment, prevention and many surprising profile stories, can be found in the links that follow:

• National Blood Clot Alliance (Stop the Clot) http://www.stoptheclot.org/
• Mayo Clinic http://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/basics/definition/con-20031922
• Centers for Disease Control and Prevention http://www.cdc.gov/ncbddd/dvt/index.html
• Blood Clot Recovery Network http://bloodclotrecovery.net/

Gratefully …

Ciao! ~ Kat

This post was in response to the Daily Post’s Weekly Photo Challenge.  ”Inside” was this week’s theme.  Everyone is welcome to join in the Challenge; further details on how to participate and links to others’ responses are found here.